Performing up to Nordic principles? Geographic and socioeconomic equity in ambulatory care sensitive conditions among older adults in capital areas of Denmark, Finland and Sweden in 2000–2015

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Denmark, Finland and Sweden pursue equity in health for their citizens through universal health care. However, it is unclear if these services reach the older adult population equally across different socioeconomic positions or living areas. Thus, we assessed geographic and socioeconomic equity in primary health care (PHC) performance among the older adults in the capital areas of Denmark (Copenhagen), Finland (Helsinki) and Sweden (Stockholm) in 2000–2015. Hospitalisations for ambulatory care sensitive conditions (ACSC) were applied as a proxy for PHC performance.

We acquired individual level ACSCs for those aged ≥ 45 in 2000–2015 from national hospitalisation registers. To identify whether the disparities varied by age, we applied three age groups (those aged 45–64, 65–75 and ≥ 75). Socioeconomic disparities in ACSCs were described with incidence rate ratios (IRR) and annual rates by education, income and living-alone; and then analysed with biennial concentration indices by income. Geographic disparities were described with biennial ACSC rates by small areas and analysed with two-level Poisson multilevel models. These models provided small area estimates of IRRs of ACSCs in 2000 and their slopes for development over time, between which Pearson correlations were calculated within each capital area. Finally, these models were adjusted for income to distinguish between geographic and socioeconomic disparities.

Copenhagen had the highest IRR of ACSCs among those aged 45–64, and Helsinki among those aged ≥ 75. Over time IRRs decreased among those aged ≥ 45, but only in Helsinki among those aged ≥ 75. All concentration indices slightly favoured the affluent population but in Stockholm were mainly non-significant. Among those aged ≥ 75, Pearson correlations were low in Copenhagen (-0.14; p = 0.424) but high in both Helsinki (-0.74; < 0.001) and Stockholm (-0.62; < 0.001) – with only little change when adjusted for income. Among those aged ≥ 45 the respective correlations were rather similar, except for a strong correlation in Copenhagen (-0.51, 0.001) after income adjustment.

While socioeconomic disparities in PHC performance persisted among older adults in the three Nordic capital areas, geographic disparities narrowed in both Helsinki and Stockholm but persisted in Copenhagen. Our findings suggest that the Danish PHC incorporated the negative effects of socio-economic segregation to a lesser degree.
TidsskriftBMC Health Services Research
Udgave nummer1
Antal sider16
StatusUdgivet - 2023

Bibliografisk note

Funding Information:
Open Access funding provided by Finnish Institute for Health and Welfare (THL). The study was funded by NordForsk (grant 74637), the Finnish Medical Foundation (grant 2273), the Academy of Finland (grant 277939), and the Strategic Research Council (SRC), an independent body established within the Academy of Finland (grants 336325 and 336328). Neither NordForsk, the Finnish Medical Foundation, the Academy nor SRC were involved in study design, data collection, findings or the decision to publish.

Funding Information:
The research team wants to thank Docent Kristiina Manderbacka at the Finnish Institute for Health and Welfare for providing us with assistance in the conception and design of the study.

Publisher Copyright:
© 2023, BioMed Central Ltd., part of Springer Nature.

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